Table 1.
Difference in differences comparison of implementation, effectiveness, and service outcomes.
| Comparison sites | Intervention sites | Difference in difference [(Change in intervention sites)—(Change in comparison sites)] Adjusted for first ANC |
||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pre (N = 480) | Post (N = 478) | Pre (N = 480) | Post (N = 481) | Point estimate | Confidence interval | p-value | ||||||
| Outcome | Definition | n (%) or median IQR | N | n (%) or median IQR | N | n (%) or median IQR | N | n (%) or median IQR | N | |||
| PrEP fidelityb | Proportion of women who receive all PrEP-specific steps in a HIV-testing visit, HIV-risk screening, PrEP-counseling/total women receiving antenatal or postnatal services [Risk screening question: “Please answer yes if you were asked about any of the following behaviors today: (Kenyan risk assessment tool HIV risk factors)”] | 4 (2.5%) | 161 | 5 (3.0%) | 164 | 14 (8.3%) | 168 | 28 (15.5%) | 181 | 7.6% | (−0.2%, 15.4%) | 0.057 |
| HIV testingd | Proportion of women HIV tested among eligible candidates (not tested in past 6 months, not known HIV positive) | 98 (60.1%) | 163 | 107 (65.2%) | 164 | 142 (84.0%) | 169 | 144 (79.6%) | 181 | −1.5% | (−12.9%, 9.9%) | 0.800 |
| PrEP risk screeningd | Proportion asked questions on HIV risk behavior characteristics (yes vs. no/don’t know) | 43 (9.0%) | 480 | 104 (21.8%) | 478 | 146 (30.5%) | 479 | 159 (33.1%) | 481 | −8.8% | (−15.9%, −1.8%) | 0.013 |
| PrEP penetrationb | Proportion of women who are counseled about PrEP / total women receiving antenatal or postnatal services (“Did anyone talk to you about PrEP today?”) | 17 (3.5%) | 480 | 8 (1.7%) | 478 | 30 (6.3%) | 480 | 46 (9.6%) | 481 | 5.4% | (1.4%, 9.3%) | 0.008 |
| PrEP offerd | Proportion offered to start or continue taking PrEP/total women receiving antenatal or postnatal services | 8 (1.7%) | 480 | 9 (1.9%) | 478 | 6 (1.3%) | 480 | 28 (5.8%) | 481 | 4.4% | (1.5%, 7.2%) | 0.002 |
| Proportion offered to start or continue taking PrEP (among those who were HIV negative and at high risk who were screened) | 3 (15.8%) | 19 | 6 (9.8%) | 61 | 4 (5.1%) | 78 | 13 (14.0%) | 93 | −5.9% | (−13.8%, 2.1%) | 0.148 | |
| PrEP uptakec | Proportion initiated PrEP today (among those offered) | 1 (12.0%) | 8 | 1 (11.0%) | 9 | 0 (0%) | 6 | 0 (0%) | 28 | – | – | – |
| Proportion initiated PrEP today (among the full population) | 1 (0.2%) | 480 | 1 (0.2%) | 478 | 0 (0%) | 480 | 0 (0%) | 481 | – | – | – | |
| PrEP continuationc | Already taking PrEP and will continue to take PrEP (among those offered) | 1 (12.5%) | 8 | 2 (22.2%) | 9 | 1 (16.7%) | 6 | 1 (3.6%) | 28 | – | – | – |
| Already taking PrEP and will continue to take PrEP (among the full population) | 5 (1.0%) | 480 | 10 (2.1%) | 478 | 9 (1.9%) | 480 | 6 (1.2%) | 481 | – | – | – | |
| Service timeb | Number of minutes receiving services from health care workers | 16 (10–33) | 192 | 14 (9–27.5) | 192 | 18 (12–36) | 192 | 17 (11–29) | 192 | −0.09a | (−0.33, 0.14)a | 0.435a |
| Waiting timeb | Number of minutes spent waiting to receive services | 37 (14.5–74) | 192 | 29 (14–46.5) | 192 | 49 (22.5–77) | 192 | 55 (31–80) | 192 | 0.33a | (0.10, 0.56)a | 0.005a |
| Client satisfactionb | Satisfaction on a scale of 0–24 points; 6 questions for clients to assess their satisfaction with services received at the facility; Likert scale (worst to best: 1–5) | 23.0 (20.0–23.0) | 480 | 23.0 (20.0–24.0) | 478 | 21.0 (19.0 −23.0) | 480 | 23.0 (21.0–23.0) | 481 | 0.66 | (0.22, 1.09) | 0.003 |
| HCW satisfactionb | Average on 4-item Intervention Appropriateness Measure (IAM) scale; Likert scale (disagree to agree: 1–5) | – | – | – | 19.5 (16.0, 20.0) | – | – | – | ||||
| Average on 4-item Acceptability of Intervention Measures (AIM) scale; Likert scale (disagree to agree: 1–5) | – | – | – | 20.0 (16.0, 20.0) | – | – | – | |||||
| Client PrEP knowledgec | All correct answers (6 questions based on content covered in counseling sessions) | 0 (0%) | 480 | 5 (1%) | 478 | 5 (1%) | 480 | 56 (11.6%) | 481 | 9.6% | (6.5, 12.8%) | <0.001 |
| Number of correct answers (0–6) | 0.975 | 480 | 1.234 | 478 | 1.042 | 480 | 3.019 | 481 | 1.72 | (1.45, 1.99) | <0.001 | |
a
Not adjusted for visit type due to visit type not collected during time-and-motion activity.
b
Primary outcome.
c
Secondary outcome.
d
Post hoc outcome.